Acquired perforating dermatosis in a British dialysis population

Abstract

A perforating disorder of the skin developing in association with chronic renal failure and often also diabetes, acquired perforating dermatosis (APD), affects up to 10% of patients receiving maintenance haemodialysis in North America. The prevalence of this condition in British dialysis patients has not yet been ascertained. We have undertaken a skin survey of our dialysis population (n = 80) to determine the prevalence and clinical presentation of APD, with subsequent assessment of disease management and outcome. Of 72 patients who participated in the survey, eight were found to have APD, seven of whom were also diabetic. Skin lesions had developed pre-dialysis in two patients, on commencement of dialysis in one, and after 1-3 years on dialysis in the remaining five. Patients typically presented with pruritic dome-shaped papules with central crusts arising on the trunk and extensor limb surfaces. Histological examination of biopsy specimens revealed two types of lesion, typified by either narrow or broad ulcer craters, each showing perforation of both collagen and elastic fibres. Topical/intradermal steroid or topical retinoid were effective therapies in certain of our patients. Clinical clearance was achieved after 3-12 months of treatment in five patients with improvement in the remaining two patients who received treatment. Of the four patients who were alive at 2-year review, three remained clear, while one patient continued to develop new lesions. We report an 11% prevalence of APD in our dialysis population, suggesting the disorder to be as prevalent in patients with chronic renal failure in Britain as in North America. An association of the disorder with long-standing diabetes was confirmed.

Cutaneous abnormalities in patients with end stage renal failure on chronic hemodialysis. A study of 458 patients.

“…47 The incidence of pseudo-Kyrle's disease is 4.5 to 10% of haemodialysis patients. 48,49 The elementary lesion is a hyperkeratotic papule or nodule with 2 to 10 mm in diameter. In most patients, pruritus precedes or occurs at the same time as nodular papulopustular lesions.…”

Acquired Perforating Dermatosis in a Patient with Poland Syndrome

“…Various systemic conditions have been observed in association with APD, primarily diabetes mellitus [7]and/or renal failure with or without dialysis [8]. APD has been observed in 11% of patients receiving dialysis [8].…”

“…APD has been observed in 11% of patients receiving dialysis [8]. In 1994, Faver et al [6]reviewed 22 patients with APD.…”

Skin Changes and Tumours after Renal Transplantation

“…Cutaneous calcifications, folliculitis perforans or other perforating dermatoses such as reactive perforating collagenoses are seldom seen [2, 15]. The development of skin symptoms resembling porphyria cutanea tarda along with the development of bullae in light-exposed areas are characteristic [16, 17]. …”

“…Symptoms of the skin resembling porphyria cutanea tarda are typically seen: pseudoporphyria [16, 17, 18]. …”